Anaesthesia and intensive care
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Traditional mechanical ventilation used tidal volumes (Vt) of between 10 to 15 ml/kg of body weight in order to achieve normal values of pH and partial pressure of carbon dioxide (PaCO2). Many clinicians today however, adopt lower volumes as a conservative 'safe' ventilation strategy in most mechanically ventilated patients. The method by which this is done varies between facilities, but anecdotally doctors use Vt of 6 to 8 ml/kg, and they commonly estimate these volumes at the bedside. ⋯ Although volumes between 6 to 8 ml/kg were recorded in 33 (60%) observations, more detailed exploration of the individual's clinical circumstances reflects that the actual dialled volumes were correct in all but two patients. Intensive care unit mortality was 13% (n=2) in those patients receiving higher than anticipated Vts (n=15). This study has demonstrated that while we achieve a protective ventilation strategy by adopting lower Vts in most mechanically ventilated patients, we should be constantly monitoring exactly what volume is being achieved, not just what is dialled up to be delivered.
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Anaesth Intensive Care · Jul 2012
ReviewThe interpretation of perioperative lactate abnormalities in patients undergoing cardiac surgery.
Hyperlactataemia and lactic acidosis are commonly encountered during and after cardiac surgery. Perioperative lactate production increases in the myocardium, skeletal muscle, lungs and in the splanchnic circulation during cardiopulmonary bypass. Hyperlactataemia has a bimodal distribution in the perioperative period. ⋯ Risk factors for late-onset hyperlactataemia include hyperglycaemia, long cardiopulmonary bypass time and elevated endogenous catecholamines. Although patients with this complication may have a longer duration of ventilation and intensive care unit length of stay than those with normolactataemia, an association with increased mortality has not been demonstrated. The discovery of late-onset hyperlactataemia should not delay the postoperative progress of an otherwise stable patient following cardiac surgery.
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We endeavored to thoroughly review Greek mythology and collect tales dealing with anaesthesia and myochalasis (paralysis). Among the evaluated sources were the poems of Hesiod, the epics of Homer, the tragedies of the great Athenian poets (namely Aeschylus, Sophocles and Euripides) as well as the contributions of several Latin writers, including Ovid. We found several examples of achieving hypnosis, analgesia and amnesia through the administration of drugs (inhaled or not) and music. ⋯ We noted that providing sleep was considered a divine privilege, although several mortals (mainly women) exhibited such powers as well. The concepts of sleep and death were closely associated in ancient classical thought. This review may stimulate anaesthetists' fantasy and may help them realise the nobility of their medical specialty.
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Controversial procedures in medicine are likely to be discussed in the community as everyone is interested in their health. If the practice is subjective, that is, clear proof is not readily forthcoming, there are likely to be both strong supporters and opponents. In the 18th and 19th centuries, when the dissemination of news was slow, such controversies lasted many years and were likely to appear in novels, drama and poetry of the period. This article gives examples of animal magnetism, mesmerism and hypnosis in contemporary literature.